The knowledge, attitudes and beliefs of patients and their healthcare professionals around oral dosage form modification: a systematic review of the qualitative literature

Objectives: The objective of this systematic review was to synthesize the available qualitative evidence on the knowledge, attitudes and beliefs of adult patients, healthcare professionals and carers about oral dosage form modification. Design: A systematic review and synthesis of qualitative studies was undertaken, utilising the thematic synthesis approach. Data sources: The following databases were searched from inception to September 2015: PubMed, Medline (EBSCO), EMBASE, CINAHL, PsycINFO, Web of Science, ProQuest Databases, Scopus, Turning Research Into Practice (TRIP), Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews (CDSR). Citation tracking and searching the references lists of included studies was also undertaken. Grey literature was searched using the OpenGrey database, internet searching and personal knowledge. An updated search was undertaken in June 2016. Review methods: Studies meeting the following criteria were eligible for inclusion; (i) used qualitative data collection and analysis methods; (ii) full-text was available in English; (iii) included adult patients who require oral dosage forms to be modified to meet their needs or; (iv) carers or healthcare professionals of patients who require oral dosage forms to be modified. Two reviewers independently appraised the quality of the included studies using the Critical Appraisal Skills Programme Checklist. A thematic synthesis was conducted and analytical themes were generated. Results: Of 5455 records screened, seven studies were eligible for inclusion; three involved healthcare professionals and the remaining four studies involved patients. Four analytical themes emerged from the thematic synthesis: (i) patient-centred individuality and variability; (ii) communication; (iii) knowledge and uncertainty and; (iv) complexity. The variability of individual patient’s requirements, poor communication practices and lack of knowledge about oral dosage form modification, when combined with the complex and multi-faceted healthcare environment complicate decision making regarding oral dosage form modification and administration. Conclusions: This systematic review has highlighted the key factors influencing the knowledge, attitudes and beliefs of patients and healthcare professionals about oral dosage form modifications. The findings suggest that in order to optimise oral medicine modification practices the needs of individual patients should be routinely and systematically assessed and decision-making should be supported by evidence based recommendations with multidisciplinary input. Further research is needed to optimise oral dosage form modification practices and the factors identified in this review should be considered in the development of future interventions.

An investigation of post-primary students' images of mathematics

This research study investigates the image of mathematics held by 5th-year post-primary students in Ireland. For this study, “image of mathematics” is conceptualized as a mental representation or view of mathematics, presumably constructed as a result of past experiences, mediated through school, parents, peers or society. It is also understood to include attitudes, beliefs, emotions, self-concept and motivation in relation to mathematics. This study explores the image of mathematics held by a sample of 356 5th-year students studying ordinary level mathematics. Students were aged between 15 and 18 years. In addition, this study examines the factors influencing students‟ images of mathematics and the possible reasons for students choosing not to study higher level mathematics for the Leaving Certificate. The design for this study is chiefly explorative. A questionnaire survey was created containing both quantitative and qualitative methods to investigate the research interest. The quantitative aspect incorporated eight pre-established scales to examine students‟ attitudes, beliefs, emotions, self-concept and motivation regarding mathematics. The qualitative element explored students‟ past experiences of mathematics, their causal attributions for success or failure in mathematics and their influences in mathematics. The quantitative and qualitative data was analysed for all students and also for students grouped by gender, prior achievement, type of post-primary school attending, co-educational status of the post-primary school and the attendance of a Project Maths pilot school. Students‟ images of mathematics were seen to be strongly indicated by their attitudes (enjoyment and value), beliefs, motivation, self-concept and anxiety, with each of these elements strongly correlated with each other, particularly self-concept and anxiety. Students‟ current images of mathematics were found to be influenced by their past experiences of mathematics, by their mathematics teachers, parents and peers, and by their prior mathematical achievement. Gender differences occur for students in their images of mathematics, with males having more positive images of mathematics than females and this is most noticeable with regards to anxiety about mathematics. Mathematics anxiety was identified as a possible reason for the low number of students continuing with higher level mathematics for the Leaving Certificate. Some students also expressed low mathematical self-concept with regards to higher level mathematics specifically. Students with low prior achievement in mathematics tended to believe that mathematics requires a natural ability which they do not possess. Rote-learning was found to be common among many students in the sample. The most positive image of mathematics held by students was the “problem-solving image”, with resulting implications for the new Project Maths syllabus in post-primary education. Findings from this research study provide important insights into the image of mathematics held by the sample of Irish post-primary students and make an innovative contribution to mathematics education research. In particular, findings contribute to the current national interest in Ireland in post-primary mathematics education, highlighting issues regarding the low uptake of higher level mathematics for the Leaving Certificate and also making a preliminary comparison between students who took part in the piloting of Project Maths and students who were more recently introduced to the new syllabus. This research study also holds implications for mathematics teachers, parents and the mathematics education community in Ireland, with some suggestions made on improving students‟ images of mathematics.

Symptom burden in individuals with inflammatory bowel disease: a mixed methods study

To investigate the symptom burden experiences of individuals with inflammatory bowel disease (IBD). An explanatory sequential mixed methods study was conducted. A cross-sectional, correlational survey was first undertaken. Symptom burden was measured using a modified disease specific version of the Memorial Symptom Assessment Scale, which was administered to a consecutive sample of individuals with IBD (n = 247) at an IBD Outpatients department in one urban teaching hospital in Ireland. Disease activity was determined using clinical disease activity indices, which were completed by the consulting physician. A sequential qualitative, descriptive study was then conducted aimed at explaining noteworthy quantitative findings. A criterion-related purposeful sample of seven participants from the quantitative study was recruited. Semi-structured face to face interviews were conducted using an interview guide and data were analysed using content analysis. Findings revealed that participants experienced a median of 10 symptoms during the last week, however as many as 16 symptoms were experienced during active disease. The most burdensome symptoms were lack of energy, bowel urgency, diarrhoea, feeling bloated, flatulence and worry. Total symptom burden was found to be low with a mean score of 0.56 identified out of a possible range from 0 to 4. Participants with active disease (M = 0.81, SD = 0.48; n = 68) had almost double mean total symptom burden scores than participants with inactive disease (M = 0.46, SD = 0.43; n = 166) (p < 0.001). Mean total psychological symptom burden was found to be significantly greater than mean total physical symptom burden (rho = 0.73, n = 247, p < 0.001). Self-reported disease control, gender, number of flare ups in the last two years, and smoking status was found to be significant predictors of total symptom burden, with self-reported disease control identified as the strongest predictor. Qualitative data revealed tiredness, pain, bowel symptoms, worry and fear as being burdensome. Furthermore, symptom burden experiences were described in terms of its impact on restricting aspects of daily activities, which accumulated into restrictions on general life events. Psychological symptom burden was revealed as more problematic than physical symptom burden due to its constant nature, with physical and psychological symptoms described to occur in a cyclical manner. Participants revealed that disease control was evaluated not only in terms of symptoms, but also in terms of their abilities to control the impact of symptoms on their lives. This study highlights the considerable number of symptoms and the most burdensome symptoms experienced by individuals with IBD, both during active and inactive disease. This study has important implications on symptom assessment in terms of the need to encompass both physical and psychological symptoms. In addition, greater attention needs to be placed on psychological aspects of IBD care.

Embodied sexualities: Exploring accounts of Irish women's sexual knowledge and sexual experiences, 1920-1970

This chapter explores the ways in which sexuality has been understood, embodied and negotiated by a cohort of Irish women through their lives. It is based on qualitative data generated as part of an oral history project on Irish women’s experiences of sexuality and reproduction during the period 1920–1970.1 The interviews, which were conducted with 21 Irish women born between 1914 and 1955, illustrate that social and cultural discourses of sexuality as secretive, dangerous, dutiful and sinful were central to these women’s interpretative repertoires around sexuality and gender. However, the data also contains accounts of behaviours, experiences and feelings that challenged or resisted prevailing scripts of sexuality and gender. Drawing on feminist conceptualisations of sexuality and embodiment (Holland et al., 1994; Jackson and Scott, 2010), this chapter demonstrates that the women’s sexual subjectivities were forged in the tensions that existed between normative sexual scripts and their embodied experiences of sexual desires and sexual and reproductive practices. While recollections of sexual desire and pleasure did feature in the accounts of some of the women, it was the difficulties experienced around sexuality and reproduction that were spoken about in greatest detail. What emerges clearly from the data is the confusion, anxiety and pain occasioned by the negotiation of external demands and internal desires and the contested, unstable nature of both cultural power and female resistance.

The international diffusion of project management

This paper examines the international diffusion of one business practice, project management, through the prism of prior literature and data on the diffusion of ISO 9000. The study took an inductive approach, building theory through the iterative collection and analysis of quantitative and qualitative data. The findings problematise the central position accorded to the S-curve model and neo-institutional theory in explaining technology diffusion. The research posits three distinct processes driving the diffusion process: utility, institutional isomorphism, and competitive isomorphism, with the latter consisting of three primary mechanisms: competitive imitation, trendslators and fashion retailers. Contrary to prior literature, national, quasi-professional associations are found to be central to the diffusion process and play a key role in advocating and containing management technologies.

Embodied sexualities: exploring accounts of Irish women’s sexual knowledge and sexual experiences, 1920–1970

This chapter explores the ways in which sexuality has been understood, embodied and negotiated by a cohort of Irish women through their lives. It is based on qualitative data generated as part of an oral history project on Irish women’s experiences of sexuality and reproduction during the period 1920–1970.1 The interviews, which were conducted with 21 Irish women born between 1914 and 1955, illustrate that social and cultural discourses of sexuality as secretive, dangerous, dutiful and sinful were central to these women’s interpretative repertoires around sexuality and gender. However, the data also contains accounts of behaviours, experiences and feelings that challenged or resisted prevailing scripts of sexuality and gender. Drawing on feminist conceptualisations of sexuality and embodiment (Holland et al., 1994; Jackson and Scott, 2010), this chapter demonstrates that the women’s sexual subjectivities were forged in the tensions that existed between normative sexual scripts and their embodied experiences of sexual desires and sexual and reproductive practices. While recollections of sexual desire and pleasure did feature in the accounts of some of the women, it was the difficulties experienced around sexuality and reproduction that were spoken about in greatest detail. What emerges clearly from the data is the confusion, anxiety and pain occasioned by the negotiation of external demands and internal desires and the contested, unstable nature of both cultural power and female resistance.

The implementation of a literacy intervention 'Station Teaching' in infant classes in Irish primary schools

Background: I conducted my research in the context of The National Literacy Strategy (DES, 2011), which maintains that every young person should be literate and it outlines targets for improving literacy in schools from 2011 to 2020. There has been much debate on the teaching of literacy and in particular the teaching of reading. Clark (2014) outlines how learning to read should be a developmental language process and that the approaches in the early years of schooling will colour the children’s motivation and their perception of reading as a purposeful activity. The acquisition of literacy begins in the home but this study focuses on the implementation of a literacy intervention Station Teaching in the infant classes in primary school. Station Teaching occurs when a class is divided into four or five small groups of pupils and they receive intensive tuition at four or five different Stations with the help of Support teachers: New Reading, Familiar Reading, Phonics, Writing and Oral Language. Research Questions: These research questions frame my study: How is Station Teaching implemented? What is the experience of the intervention Station Teaching from the participants’ point of view: teachers, pupils, parents? What notion of literacy is Station Teaching facilitating? Methods: I chose a pragmatic parallel mixed methods design as suggested by Mertens (2010). I collected and analysed both the quantitative and qualitative data to answer the study’s research questions. In the study the quantitative data were collected from a questionnaire issued to 21 schools in Ireland. I used Excel as a data management package and thematic analysis to analyse and present the data in themes. I collected qualitative data from a case study in a school. This data included observations of two classes over a period of a year; interviews with teachers, pupils and parents; children’s drawings, photographs, teachers’ diaries and video evidence. I analysed and presented the evidence from the qualitative data in themes. Main Findings: There are many skills and strategies that are essential to effective literacy teaching in the early years including phonological awareness, phonics, vocabulary, fluency, comprehension and writing. These skills can be taught during Station Teaching. Early intervention in the early years is essential to pupils’ acquisition of literacy. The expertise of the teacher is key to improving the literacy achievement of pupils Teachers and pupils enjoy participating in ST. Pupils are motivated to read and engage in meaningful activities during ST. Staff collaboration is vital for ST to succeed ST facilitates small group work and teachers can differentiate accordingly while including all pupils in the groups. Pupils’ learning is extended in ST but extension activities need to be addressed in the Writing Station. More training should be provided for teachers on the implementation of ST and more funding for resources should be available to schools Significant contribution of the work: The main significance of the study includes: insights into the classroom implementation of Station Teaching in infant classes and extensive research into characteristics of an effective teacher of literacy.

Forces of agglomeration and dispersal in rural business networks: a social network analysis

Two concepts in rural economic development policy have been the focus of much research and policy action: the identification and support of clusters or networks of firms and the availability and adoption by rural businesses of Information and Communication Technologies (ICT). From a theoretical viewpoint these policies are based on two contrasting models, with clustering seen as a process of economic agglomeration, and ICT-mediated communication as a means of facilitating economic dispersion. The study’s conceptual framework is based on four interrelated elements: location, interaction, knowledge, and advantage, together with the concept of networks which is employed as an operationally and theoretically unifying concept. The research questions are developed in four successive categories: Policy, Theory, Networks, and Method. The questions are approached using a study of two contrasting groups of rural small businesses in West Cork, Ireland: (a) Speciality Foods, and (b) firms in Digital Products and Services. The study combines Social Network Analysis (SNA) with Qualitative Thematic Analysis, using data collected from semi-structured interviews with 58 owners or managers of these businesses. Data comprise relational network data on the firms’ connections to suppliers, customers, allies and competitors, together with linked qualitative data on how the firms established connections, and how tacit and codified knowledge was sourced and utilised. The research finds that the key characteristics identified in the cluster literature are evident in the sample of Speciality Food businesses, in relation to flows of tacit knowledge, social embedding, and the development of forms of social capital. In particular the research identified the presence of two distinct forms of collective social capital in this network, termed “community” and “reputation”. By contrast the sample of Digital Products and Services businesses does not have the form of a cluster, but matches more closely to dispersive models, or “chain” structures. Much of the economic and social structure of this set of firms is best explained in terms of “project organisation”, and by the operation of an individual rather than collective form of “reputation”. The rural setting in which these firms are located has resulted in their being service-centric, and consequently they rely on ICT-mediated communication in order to exchange tacit knowledge “at a distance”. It is this factor, rather than inputs of codified knowledge, that most strongly influences their operation and their need for availability and adoption of high quality communication technologies. Thus the findings have applicability in relation to theory in Economic Geography and to policy and practice in Rural Development. In addition the research contributes to methodological questions in SNA, and to methodological questions about the combination or mixing of quantitative and qualitative methods.